Provider Demographics
NPI:1174625800
Name:SOBREVILLA, LUIS ALBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ALBERTO
Last Name:SOBREVILLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 SUNRISE DR
Mailing Address - Street 2:APT M
Mailing Address - City:KEY BISCAYNE
Mailing Address - State:FL
Mailing Address - Zip Code:33149-2154
Mailing Address - Country:US
Mailing Address - Phone:305-365-0535
Mailing Address - Fax:
Practice Address - Street 1:1401 SW 1ST ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2261
Practice Address - Country:US
Practice Address - Phone:305-649-1100
Practice Address - Fax:305-649-2060
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0063233208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23462Medicare ID - Type Unspecified
FLF70319Medicare UPIN